First-Line Switch to B/F/TAF for Treatment of HIV in Older Adults ≥60 Years in Kenya (the B/F/TAF-Elderly Study)

By
Loice Achieng Ombajo
Jeremy Penner
Joseph Nkuranga
Victor Omodi
Edwin Otieno
Jared Ongechi Mecha
Simon Wahome
Florentius Ndinya
Rukia Aksam
Sanjay Bhagani
Rose Wafula
Anton Pozniak
Diana Nyakoe
On behalf of
the B/F/TAF-Elderly Study Group
Ruth Wanjohi
Arnold Onyango
Foram Bhogayata
Janet Oyoo
Susan Onywera
Martha Atandi
Agatha Theuri
Beryl Handa
Elizabeth Kamau
Susan Wanjiru
Eunice Karuoya
Amos Ongubo
Gerald Kiambi
Sheila Eshiwani Juliet
Lillian Gekonge
Florence Kinyanjui
Betty Chepchumba
Alex Morwabe
Kevin Wauna
Felix Hinga
November 20, 2025
0 min

Open Forum Infectious Diseases

At a Glance

Category	Detail
Condition	HIV infection in older adults (≥60 years) with comorbidities
Key Mechanisms	Switching from current antiretroviral regimen to bictegravir/emtricitabine/tenofovir alafenamide (B/F/TAF) to improve bone mineral density and maintain viral suppression
Target Population	Virally suppressed people with HIV aged 60 years and above in Kenya
Care Setting	HIV treatment clinics in resource-limited settings in Kenya

Key Highlights

Switch to B/F/TAF was non-inferior to continuing current antiretroviral regimen in maintaining viral suppression at 48 weeks.
B/F/TAF arm showed significant improvement in lumbar spine bone mineral density (+2.18%) compared to current regimen (+0.68%).
Treatment-related grade 3 or 4 adverse events were similar between arms; kidney function decline leading to discontinuation occurred only in the current regimen arm.

Guideline-Based Recommendations

Diagnosis

Confirm viral suppression with HIV-1 RNA <50 copies/mL before switching therapy.
Assess bone mineral density where feasible, especially in older adults at risk for osteoporosis.
Evaluate kidney function prior to initiating or switching antiretroviral therapy.

Management

Consider switching older PWH from TDF-containing regimens to B/F/TAF to reduce bone and kidney toxicity.
Provide calcium and vitamin D supplementation in patients with osteoporosis or at risk.
Monitor for incident dyslipidemia when switching to B/F/TAF.

Monitoring & Follow-up

Regularly monitor plasma HIV-1 RNA to ensure continued viral suppression.
Monitor bone mineral density changes, particularly lumbar spine BMD, at baseline and during follow-up.
Monitor kidney function periodically to detect decline, especially in patients on TDF-containing regimens.
Monitor lipid profiles due to increased dyslipidemia risk with B/F/TAF.

Risks

Potential for incident dyslipidemia with B/F/TAF requiring cardiovascular risk assessment.
Risk of kidney function decline with TDF-containing regimens, particularly in older adults.
Polypharmacy and comorbidities increase risk of adverse drug reactions in older PWH.

Patient & Prescribing Data

Older adults (≥60 years) living with HIV in Kenya, virally suppressed on current antiretroviral therapy.

Switching to B/F/TAF maintains viral suppression with improved bone mineral density and fewer kidney-related adverse events but may increase dyslipidemia risk.

Clinical Best Practices

Screen older PWH for osteoporosis and kidney function impairment before selecting antiretroviral regimen.
Use B/F/TAF as a safer alternative to TDF-containing regimens in older adults to preserve bone and kidney health.
Implement calcium and vitamin D supplementation in patients with low bone mineral density.
Monitor lipid profiles and manage cardiovascular risk factors when switching to B/F/TAF.
Ensure ongoing viral load monitoring to detect virological failure early.